Pa. eliminating easy stopgap health coverage for poor

If you are poor in Pennsylvania and temporarily disabled, a health-care worker can fill out a one-page form that qualifies you to receive medical care paid for by the state.

But that is changing under a new policy, requiring more paperwork, that Gov. Corbett is implementing, arguing that it will save taxpayers money without denying significant numbers of people medical care.

Health-care workers and advocates for the poor, however, say the new policy could leave thousands of people without needed care and drive up medical costs in the long run.

"They are using this as a way to deny people health insurance," said Gene Bishop, a doctor who directs a clinic at Pennsylvania Hospital. "These are sick people with chronic conditions, and they are going to get sicker."

In the budget completed June 30, state welfare workers identified $170 million in savings in the Medical Assistance program, which is state-funded Medicaid for people with short-term disabilities.

Anne Bale, a spokeswoman for the state Department of Public Welfare (DPW), said the bulk of those savings will occur because most people who got Medical Assistance also got General Assistance, which paid them $205 a month in income. The Corbett administration eliminated General Assistance and believes many recipients will not reapply for Medical Assistance only.

Those who do seek health care via Medical Assistance must have a health-care provider fill out a new, longer set of questions, but the queries are not designed to disqualify people, Bale said.

"It's in place to do a better job, not to remove people from a benefit," Bale said. It is possible that the new eligibility requirements will eliminate some people, she said, but that is not its intent.

State welfare officials expect the new form to be put in place soon but could not give an exact date.

The $170 million from the Medical Assistance budget this year represents about 3.7 percent of the total program spending, said Barry Ciccocioppo, a Democratic staffer on the Pennsylvania House Appropriations Committee.

Medical Assistance provides health care to about 125,000 Pennsylvanians with short-term disabilities. Recipients can earn no more than $205 a month, said Kristen Dama, a lawyer for Community Legal Services who helps clients qualify for the program.

"The people we see the most are ... people who are facing flare-ups of long-term conditions, often issues like anxiety, long-term depression, that prevent them from working steadily for a long period of time," Dama said.

The current form requires a medical worker to fill out a single page that includes a diagnosis and determination of whether the person's disability prevents "gainful employment." The new one requires health-care providers to fill out three pages of paperwork, ranking patients on their abilities in 12 categories.

Category Three, for example, is titled "Reaching" and asks the person filling out the form to check off whether the patient:

A. Cannot raise either arm as if to put something in the top pocket of a coat or jacket.

B. Cannot raise either arm to top of head as if to put on a hat.

C. Cannot raise either arm above head height as if to reach for something.

D. None of the above applies.

Depending on how many A's, B's C's, and D's are checked, the patient's application would either be fast-tracked to qualify for medical assistance or go to the state for further review.

People must reapply for Medical Assistance yearly and confirm ongoing eligibility every six months.

Pat Dillon, a social worker at 11th Street Family Health Services in Philadelphia, said she believes many patients who need care won't qualify using the new form because it fails to address many medical problems that cause short-term disability. The process also adds to the paperwork burden for medical providers, who already struggle to keep up, she added.

"This really seems only a mechanism to deny people," Dillon said, "and you're asking a medical provider to take time from an appointment to fill out unnecessary paperwork."

The DPW's Bale said department officials believed the old form was a problem. It contained so little information about a patient's medical issues that welfare workers often had to go back to clients and health-care providers to get more information, which was inefficient.

She also said the department believes the extra questions will help ensure that recipients get medical assistance for the appropriate amount of time.

Many people have lost health coverage since Corbett took office. His administration also ended adultBasic, a health-care program for 40,000 low-income working people, saying the state could no longer afford it.

Thousands more children and adults lost Medicaid benefits because, advocates said, the state botched efforts to plow through a backlog of eligibility reviews.

State officials, however, denied that, saying that most of those cut were dead, had moved out of state, or were found to be ineligible.

Dillon and Bishop said the 12 categories would be largely irrelevant to many of the patients they see.

Dillon cited a recent patient who broke a leg and needed surgery but had no coverage. Medical professionals are trying to help the woman qualify for Medical Assistance so she can have surgery. She can't work because she can't walk, but it's not clear that would qualify her as temporarily disabled under the new rules, Dillon said.

Bishop said many patients she has seen have multiple problems, such as poorly managed diabetes, high blood pressure, or a lack of education that limits job options.

She deems some of those patients unemployable but thinks many would not qualify for Medical Assistance with the new questions.

"Disability is a judgment. It's always a judgment," Bishop said. "To me, you are taking a very complex subject, you are redefining it, you are limiting the definition of disability to quite a different definition than has been the norm."

Denying care to someone with a chronic illness such as diabetes could cause complications, including the need to amputate, Bishop said. That will only drive up costs, she added.

"For someone like this to be without health insurance," Bishop said, "is only more of a disaster."

DPW's Bale, however, said state welfare officials believe some of those patients would qualify. A question about whether someone experiences episodes of "altered consciousness" could apply to a diabetic, for example, she said.

The recent Supreme Court decision on health care could mean that those who qualify for state-funded Medical Assistance would instead be covered by federally funded Medicaid in 2014, but that would happen only if the Corbett administration agreed to it.